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Separation anxiety among birth-assigned male children in a specialty gender identity service

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Abstract

Previous research suggested that separation anxiety disorder (SAD) is overrepresented among birth-assigned male children clinic-referred for gender dysphoria (GD). The present study examined maternally reported separation anxiety of birth-assigned male children assessed in a specialty gender identity service (N = 360). SAD was determined in relation to DSM-III and DSM-IV criteria, respectively. A dimensional metric of separation anxiety was examined in relation to several additional factors: age, ethnicity, parental marital status and social class, IQ, gender nonconformity, behavioral and emotional problems, and poor peer relations. When defined in a liberal fashion, 55.8% were classified as having SAD. When using a more conservative criterion, 5.3% were classified as having SAD, which was significantly greater than the estimated general population prevalence for boys, but not for girls. Dimensionally, separation anxiety was associated with having parents who were not married or cohabitating as well as with elevations in gender nonconformity; however, the association with gender nonconformity was no longer significant when statistically controlling for internalizing problems. Thus, SAD appears to be common among birth-assigned males clinic-referred for GD when defined in a liberal fashion, and more common than in boys, but not girls, from the general population even when more stringent criteria were applied. Also, the degree of separation anxiety appears to be linked to generic risk factors (i.e., parental marital status, internalizing problems). As such, although separation anxiety is common among birth-assigned male children clinic-referred for GD, it seems unlikely to hold unique significance for this population based on the current data.

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Notes

  1. Children who present clinically for GD are a heterogeneous population with respect to identity presentation at initial assessment in that some will have retained their birth-assigned gender identity, while others will identify with or be in the process of transitioning to an experienced gender identity that differs from the one assigned at birth. Here, in reference to children clinic-referred for GD, we use the terms “male” and “female” to refer to an individual’s sex based on somatic characteristics associated with sex development that are readily observable at birth (i.e., genitals) as opposed to the gender identity terms “boy” and “girl.”

  2. Shear et al. [9] reported the US population prevalence of childhood SAD as 4.1% and an elevated prevalence among girls compared to boys with an odds ratio of 2.2. The estimated prevalence of SAD among boys and girls, respectively, was extrapolated from this information.

  3. The SAD diagnostic criteria were similar across DSM-III and DSM-III-R [18, 19] as well as across DSM-IV and DSM-IV-TR [10, 20]—although the criteria were revised between DSM-III-R and DSM-IV (see “Method” for details). Thus, hereafter, reference is only made to DSM-III and DSM-IV.

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Acknowledgements

DPV was supported by a Canadian Institutes of Health Research Postdoctoral Fellowship, the Centre for Addiction and Mental Health, and the University of Toronto Mississauga. AS and ANN were supported by University of Toronto Excellence Awards funded by the Social Sciences and Humanities Research Council of Canada.

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Authors and Affiliations

  1. Department of Psychology, University of Toronto Mississauga, Deerfield Hall, 3359 Mississauga Rd. N., Mississauga, ON, L5L 1C6, Canada

    Doug P. VanderLaan, Alanna Santarossa & A. Natisha Nabbijohn

  2. Underserved Populations Research Program, Child, Youth and Family Division, Centre for Addiction and Mental Health, Toronto, ON, Canada

    Doug P. VanderLaan

  3. Psychological Services, Toronto District School Board, Toronto, ON, Canada

    Hayley Wood & Allison Owen-Anderson

  4. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Kenneth J. Zucker

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  1. Doug P. VanderLaan
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Correspondence to Doug P. VanderLaan.

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VanderLaan, D.P., Santarossa, A., Nabbijohn, A.N. et al. Separation anxiety among birth-assigned male children in a specialty gender identity service. Eur Child Adolesc Psychiatry 27, 89–98 (2018). https://doi.org/10.1007/s00787-017-1018-7

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  • DOI: https://doi.org/10.1007/s00787-017-1018-7

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